Study on correlation between TYMS gene mRNA expression and EGFR gene mutation in stage Ⅲ A-N2 non-small-cell lung cancer tissue / 重庆医学

Objective To investigate the correlation between TYMS gene mRNA expression level and EGFR mutation in stage Ⅲ A-N2 non-small-cell lung cancer tissue (NSCLC).Methods The branched DNA-liquidchip technology (bDNA-LCT) and mutant-enriched liquidchip (MEL) technology were used to detect the TYMS mRNA expression and EGFR mutations at exon 19 and 21 in NSCLC tissues from 30 patients with stages Ⅲ A-N2 NSCLC,and the results were analyzed.Results Among 30 cases,low TYMS mRNA expression was in 14 cases (46.7 ％),middle to low TYMS mRNA expression in 7 cases (23.3 ％),middle mRNA expression in 7 cases (23.3 ％),middle to high TYMS mRNA expression in 0 case and high TYMS mRNA expression in 2 cases (6.7％);12 cases of EGFR mutation were detected out with the mutation rate of 40.0％,including 6 cases of exon 19 deletion and 6 cases of exon 21 missense mutation.The TYMS mRNA expression level was correlated with the EGFR mutation.The EGFR mutation commonly occurred in the tumor tissue of the patients with TYMS mRNA low expression (Z=-2.604,P=0.009).Conclusion The TYMS mRNA expression in NSCLC tissue is correlated with the EGFR gene mutation,which can provide references for the drug selection aiming at the patients with different conditions.

Accuracy of endoscopic ultrasonography for evaluating T3 esophageal squamous cell carcinoma / 中华消化外科杂志

Objective To explore the accuracy of endoscopic ultrasonography (EUS) for evaluating T3 esophageal squamous cell carcinoma (ESCC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 733 patients diagnosed with T3 ESCC by preoperative EUS who were admitted to the Sun Yat-sen University Cancer Center from January 2003 to December 2015 were collected.All the patients underwent radical resection of ESCC.The postoperative pathological stage as a gold standard,the accuracy,overstaged and understaged rates of clinical staging by preoperative EUS were assessed.Observation indicators:(1) comparison between clinical T staging evaluated by preoperative EUS and postoperative pathological T staging;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect patients' diseases and postoperative survival up to December 30,2016.Overall survival time was from operation time to death or last effective follow-up.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).Count data were represented as cases and percentage.The survival curve was drawn by the Kaplan-Meier method,and survival analysis was done using the Log-rank test.Results (1) Comparison between clinical T staging evaluated by preoperative EUS and postoperative pathological T staging:all the 733 patients were confirmed as T3 ESCC by preoperative EUS.Postoperative pathological diagnosis showed that 9 patients were detected in pT1b,87 in pT2,630 in pT3 and 7 in pT4a.The accuracy,overstaged and understaged rates of preoperative EUS in evaluating T3 ESCC were 85.95％(630/733),13.10％(96/733) and 0.95％(7/733),respectively.N0,N1,N2 and N3 of postoperative pathological N stage were respectively detected in 329,247,110 and 47 patients.Twenty-seven,323 and 383 patients were in stage Ⅰ,Ⅱ and Ⅲ of TNM stage,respectively.The high-,moderate-and lowdifferentiated tumors were respectively detected in 125,403 and 205 patients.(2) Follow-up and survival situations:among 733 patients,639 were followed up for 1.0-153.0 months,with a median time of 29.0 months.The median survival time,1-,3-,5-year overall survival rates were 53.0 months (range,37.7-68.3 months),85.3％,58.1％ and 48.2％ in 733 patients,respectively.The 5-year overall survival rate was 75.2％ in 9 patients with pT1b,63.0％ in 87 patients with pT2,46.3％ in 630 patients with pT3 and 0 in 7 patients with pT4a,respectively,with a statistically significant difference (x2=24.089,P＜0.05).Conclusion There is a higher accuracy of EUS for evaluating T3 ESCC,however,the stage migration should be noted.

Epidermal growth factor receptor mutations in primary tumors, N2 lymph nodes, and plasma samples in Chinese patients with stageⅢA-N2 non-small cell lung cancer / 中国肿瘤临床

Objective:Mutations in epidermal growth factor receptor (EGFR) can predict tumor response to tyrosine kinase inhibitors (TKIs) in non-small cell lung cancer (NSCLC). However, not all cases of NSCLC with EGFR mutations can respond well;thus, discovering the heterogeneity of NSCLC at the molecular level is necessary. This study aimed to determine the discrepancy in EGFR mutations in primary tumors, N2 lymph nodes, and plasma samples. Methods:Primary tumors, N2 lymph nodes, and plasma samples obtained from 49 patients with stageⅢA-N2 NSCLC were analyzed for EGFR mutations in exons 19 and 21 by using mutant-enriched liquidchip technology. Results:In 49 patients, we detected 18 (36.7%) EGFR mutations in primary tumors, 11 (22.4%) mutations in N2 lymph nodes, and 2 (4.1%) mutations in plasma samples. Eleven (22.4%) cases showed discordance in EGFR mutations between primary tu-mors and N2 lymph nodes. In nine cases, EGFR mutations were detected only in primary tumors, whereas EGFR mutations were de-tected only in N2 lymph nodes in two cases. In addition, EGFR mutations were detected in the plasma samples of two patients, who al-so carry mutations in their primary tumors. Conclusion:A considerable proportion of NSCLC cases showed discrepancy in EGFR muta-tions between primary tumors and N2 lymph nodes. In addition, the detection rate of EGFR mutations was lower in plasma samples obtained from patients with stage IIIA-N2 NSCLC. All of the results indicated tumor heterogeneity at the molecular level during metas-tasis, and this heterogeneity may have implications during treatment with TKIs.

Survival analysis of patients with pathologic T2-3N0 squamous cell carcinoma of thoracic esophagus after esophagectomy / 肿瘤研究与临床

Objective To analyze the clinicopathologic features of patients with pathologic T2-3N0 thoracic esophageal squamous cell carcinoma (ESCC) and correlation to their prognosis.Methods The clinicopathologic data of 422 patients with pathologic T2-3N0 thoracic ESCC,who were treated with surgery were analyzed.Cumulative survival rate was analyzed by the Kaplan-Meier method and compared by Log-rank test.Cox regression model was used for multivariate prognostic analysis.Results The overall 1-,3-and 5-year survival rates were 89.3 ％,63.5 ％ and 52.5 ％,respectively.Univariate analysis revealed that the factors affecting the prognosis included gender (x2 =7.45,P ＜ 0.01),depth of invasion (x2 =7.79,P ＜ 0.01) andtissues differentiation (x2 =15.81,P ＜ 0.01).They were also independent prognostic factors according Cox regression multivariate survival analysis.Conclusion The gender,depth of invasion and differentiation should be independent prognostic factors of pathologic T2-3N0 ESCC.Surgery is still the standard treatment for pathologic T2-3N0 esophageal cancer.

Olive oil-based lipid emulsion for parenteral nutrition in patients after esophagectomy / 中华临床营养杂志

Objective To assess the safety and efficacy of an olive oil-based lipid emulsion for parenteral nutrition in patients after esophagectomy.Methods In the randomized controlled trial,60 patients undergoing esophagectomy were divided into study group(n=30,received olive oil-based lipid emulsion)and control group [n=30,received medium-chain triglyceride/long-chain triglyceride(MCT/LCT)emulsion].The parenteral nutrition Was provided for 7-10 postoperative days.The nutritional formulas were equivalent in nitrogen,calorie,osmotic pressure,and fluid volume.Peripheral venous blood tests were performed before operation and on the first and eighth postoperative days.All the patients were evaluated by nutritional status(weight,body mass index,nutritional risk screening,etc.),safety profiles[full blood test,electrolytes,aspartate aminotransferase(AST),alanine amiotransferase(ALT),total bilirubin and direct bilirubin,blood urea nitrogen(BUN),creatinine,blood glucose,etc.],and efficacy indicators(hemoglobin,albumin,total protein,etc.).Results The albumin and total protein levels returned to the normal ranges in beth groups 8 days after operation,although both levels were significantly higher in study group(P=0.000).Also,the difference of total protein levels between the eighth and first postoperative days Was significantly higher in the study group(P=0.002).In addition,the AST and BUN readings returned to normal ranges 8 days after operation in the study group, which were significantly lower than those in control group (P = 0.025, P = 0.013).No serious adverse events were reported in both groups.Other nutritional parameters, renal and hepatic safety profiels, vital signs, and hematology showed no significant difference between two groups.Conclusions Olive oil-based lipid emulsion is a safe and efficient lipid emulsion for parenteral nutrition in patients undergoing esophagectomy.Compared with MCT/LCT, it has less effect on AST and BUN.

Expression of XIAP mRNA and Survivin mRNA in non-small cell lung cancer and their clinical significance / 肿瘤研究与临床

Objective To investigate the clinical significance of the expression of XIAP mRNA and Survivin mRNA in non-small cell lung cancer and their relationship. Methods RT-PCR was used to evaluate the expression of XIAP mRNA and Survivin mRNA in 59 cases of NSCLC and corresponding normal tissues.Results There was a significant difference in XIAP mRNA expression in primary lung and corresponding normal tissues (61.0 % vs 30.5 %, P<0.05), whereas there were no significant correlation between the XIAP mRNA expression and gender, age, smoking history, histological subtype, T stage, lymph node metastatic status and TNM stage. There was a significant difference in Survivin mRNA expression in primary lung and corresponding normal tissues (81.4 % vs 23.7 %, P<0.05), whereas there were no significant correlation between the Survivin mRNA expression and gender, age, smoking history, histological subtype, T stage, lymph node metastatic status and TNM stage. Conclusion The significant difference of XIAP mRNA and Survivin mRNA expression between the tumor and corresponding normal tissues implies they might play important roles in the carcinogenesis and progress of NSCLC and might become marker for the diagnosis and target for treatment of NSCLC.

Experimental study of bio-material artificial chest wall for reconstruction of huge bony defects of chest wall in mongrels / 中华创伤杂志

Objective To build a bio-material artificial chest wall and discuss its feasibility and efficiency in reconstruction of huge bony defects of chest wall in mongrels in comparison with traditional "sandwich" procedure. Methods (1) The procine osteal and membranate tissues were treated with epoxy cross linking method and their surfaces were modified with amino acid solutions at various concen-trations and at different temperatures to obtain an artificial pleura and artificial ribs for construction of the artificial chest wall. (2) The huge bony defects (5 cm×5 cm) were created in chest wall of five Chinese mongrels. (3) Three mongrels in test group was repaired with artificial chest wall, while two mongrels in control group was repaired with traditional "sandwich" complex. A follow-up was carried out to observe reconstruction effect and rejection in both groups at 3,6 and 12 months after implantation. Results There was no death found during the perioperative period and at 12 month follow-up in test group, with abnormal contour of chest wall and good thoracic activity after reconstruction. In the meantime, there found no rejection, collapse in the repaired region or paradoxical respiration. The postoperative X-rays at 3,6,12 and 24 months showed a good integrity of the thorax, with no collapse, deformation or abnormal movement. Meanwhile, the follow-up of control group showed a normal contour but slight collapse, with no paradoxical respiration. The Chest X-ray examination revealed that the bone cement in" sandwich" complex was X ray opaque and showed mild abnormal movement with breathing. The common blood test and immune items showed no abnormal. Conclusions The bio-material artificial chest wall is a safe and effective reconstruction technique for bony defects of thoracic wall in mongrels, with no acute or chronic rejection.

Retrospective study of clinicopathological characteristics in bronchopulmonary carcinoid / 中国肺癌杂志

<p><b>BACKGROUND AND OBJECTIVE</b>Bronchopulmonary carcinoid (BPC) account for less than 2% of all primary lung malignant tumors, but few related studies were reported. The aim of this study is to analyze this rare disease's clinicopathological characteristics.</p><p><b>METHODS</b>The clinical data of 28 patients with BPC in Cancer Center of Sun Yat-sen University, from January 1994 to June 2009, were enrolled into retrospective analysis. First, the corresponding paraffin blocks reexamined, slice up and stained, multiple pathologists re-consulted, and its subsets (typical carcinoid, TC; atypical carcinoid, AC) defined. Second, the clinical characteristics and immunohistochemical markers and its relationship with prognosis were analyzed.</p><p><b>RESULTS</b>First, the 5-year survival for overall and TC, AC was 56% and 70%, 41% respectively in 28 cases. The markers CD99, Bcl-2 and Ki-67 expression correlated significantly with the BPC subsets (P = 0.017, P = 0.043, and P = 0.033 respectively). Further univariate analysis revealed that advanced TNM staging (P = 0.037), lymph node metastasis (P = 0.001) and Ki-67 nucleolus's positive expression (P = 0.009) are poor prognostic factors. Second, the overall, TC, AC 5-year survival rate was 73%, 83%, 57% respectively in 20 cases underwent the radically surgical resection. Further univariate analysis revealed that AC subset (P = 0.013), lymph node metastasis (P = 0.004) and Ki-67 nucleolus's positive expression (P = 0.006), advanced TNM staging (P = 0.047) are poor prognostic factors in this 20 cases. Third, as univariate analysis, local recurrence and metastasis (n = 4) correlate significantly with Ki-67 nucleolus's and Bcl-2 positive expression (P = 0.027, 0.045, respectively).</p><p><b>CONCLUSION</b>The prognosis of BPC was better than other types of primary lung cancer. Ki-67, Bcl-2 high expression and advanced TNM staging are the poor recurrence and prognostic factors of BPC. The radical surgery remains the treatment of choice for resectable candidates in BPC as NSCLC.</p>

Clinical Study of Lymph Node Metastasis and Optimal Lymphadenectomy for Middle Third Thoracic Esophageal Squamous Cell Carcinoma / 中国肿瘤临床

Objective: To explore the status of lymph node metastasis of middle third thoracic esophageal squamous cell carcinoma and its influence on the prognosis and to seek the reasonable range of lymphade-nectomy. Methods: A total of 129 patients who underwent curative esophagectomy with modern two-field lymphadenectomy of middle third thoracic esophageal squamous cell carcinoma were reviewed. Results: The lymph node metastasis rate was 56.6% and the upper mediastinal lymph node metastasis rate was 43.4%. The lymph node metastasis ratio (positive nodes/total dissected nodes, LMR) was 11.3%. Paraesophageal lymph nodes, lymph nodes near the right recurrent nerve, the left gastric and infracadnal lymph nodes were most commonly involved when the tumor was located in the middle thoracic esophagus. Tumor differentiation, the depth of tumor invasion and the length of tumor were influencing factors for lymph node metastasis. The 5-year survival of N_0, N_1 (LMR≤20%) and N_1 (LMR>20%) patients were 50.4%, 31.0% and 6.8%, respective-ly, with a significant difference among the three groups (P=0.000). Conclusion: LMR was one of the key fac-tors affecting the prognosis, of esophageal cancer. Patients with middle third thoracic esophageal carcinoma should be treated with radical surgery with modern two-field lymphadenectomy.

Features of lymph node metastasis and its effects on the prognosis of patients after radical operation for thoracic esophageal squamous cell cancer / 中华消化外科杂志

Objective To investigate the features of lymph node metastasis and its effects on the prognosis of patients after radical operation for thoracic esophageal squamous cell cancer, and investigate the reasonable postoperative adjuvant protocol. Methods Multivariate analysis of the clinical data of 204 patients was carried out by Spearman correlation analysis, Cox model and Kaplan-Meier method. Results The lymph node metastasis rate was 40.2% (82/204), and 166 out of 2193 dissected lymph nodes had metastasis with the rate of 7.57%. The analysis of related factors revealed that the invasion depth, tumor length and differentiation grade were significantly associated with the postoperative lymph node metastasis (χ2 = 17.466, 11.494, 6.767, P <0.05), while age, tumor site were not significantly correlated with the postoperative lymph node metastasis (χ2=1.086, 3.897, P > 0.05). Kaplan-Meier analysis showed that the 1-, 3-, 5-year survival rates of patients with < 4 lymph nodes metastasis were significantly higher than those with ≥4 lymph nodes metastasis (χ2=4.493, 4.494, 4.450, P < 0.05). The recurrence and metastasis were more often occurred in patients with lymph node metastasis compared with those without lymph node metastasis (r=-2.060, -4.296, P <0.05). Multivariate analysis confirmed that the pathological stage, tumor differentiation grade, and the postoperative adjuvant treatment were the independent prognostic factors. Conclusions The invasion depth, tumor length and differentiation grade are significantly associated with the postoperative lymph node metastasis. The lymph node metastasis state and the number of involved lymph nodes affect the prognosis of patients. Oral administration of 5-FU is benefit to the patients without lymph node metastasis.

Survival analysis of completely resected stage IIIB non-small cell lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>Most stage IIIB (T4/N3) non-small cell lung cancer (NSCLC) can not be cured via operation, but how is the outcome for those with T4 or occasionally N3 which can be completely resected? This paper retrospectively analyses the effects of the tumor characteristics and postoperative treatments on the survival of 51 patients with stage IIIB NSCLC completely resected in this hospital from January 1, 1997 to April 30, 2001.</p><p><b>METHODS</b>The effects of clinical pathophysiological characteristics such as gender, histological type, differentiation, T-stage and lymph node status and the postoperative chemotherapy or radiotherapy on the prognosis of 51 patients with completely resected stage IIIB NSCLC were retrospectively analysed.</p><p><b>RESULTS</b>There were no statistic survival differences in the disease characteristics such as the different gender (Log rank=0.992, P=0.319), histological types (Log rank=1.263, P=0.260), differentiation (Log rank=1.104, P=0.577), T-stage (Log rank=0.106, P=0.588) and lymph node status (Log rank=1.297, P=0.731), also no difference between groups whether or not there was postoperative mediastinal radiotherapy (Log rank=0.482, P=0.488) or postoperative chemotherapy (Log rank=0.051, P=0.759).</p><p><b>CONCLUSIONS</b>Neither the tumor characteristics such as gender, histological type, differentiation, T-stage and N-stage, nor the postoperative mediastinal radiotherapy or chemotherapy affect the survival of stage IIIB NSCLC with complete resection.</p>

A prospective randomized study of adjuvant chemotherapy in completely resected stage IIIA-N2 non-small cell lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>Recently, results from IALT, JBR10 and CALGB9633 showed that postoperative adjuvant chemotherapy improved survival rate of patients with non-small cell lung cancer (NSCLC) after complete resection. The aim of this study is to evaluate the effect of postoperative adjuvant chemotherapy on survival after complete resection for stage IIIA-N2 NSCLC.</p><p><b>METHODS</b>From Jan 1999 to Dec 2003, one-hundred and fifty patients with stage IIIA-N2 NSCLC were randomly divided into two groups. The chemotherapy group received four cycles of chemotherapy with navelbine or paclitaxel plus carboplatin, while the observation group did not receive chemotherapy after operation.</p><p><b>RESULTS</b>In the chemotherapy group, 86.1% (68/79) of patients finished 4 cycles of chemotherapy, and no one died of toxic effects of chemotherapy; 25% of patients had grade III-IV leukopenia, 2% of patients had febrile leukopenia. The median survival time for the entire 150 patients was 879 days, and 1-, 2- and 3-year survival rate was 81%, 59% and 43%. There was no significant difference in median survival between the chemotherapy and observation groups (P= 0.0527), but there was significant difference in the 1- and 2-year survival rate (94.71% and 76.28% vs 88.24% and 60.13%, P < 0.05). The most common site of recurrence was the brain. Twenty-six percent (39/150) of patients recurred in the brain as their first site of failure, and 22.8% (18/79) for the chemotherapy group, 29.6% (21/71) for the observation group. The median survival time for patients who developed brain metastasis was not significantly different between the chemotherapy and observation groups (812 days vs 512 days, P=0.122), but there was significant difference in the 2-year survival rate (66.7% vs 37.6%, P < 0.01). The median survival was 190 days for the patients since brain metastasis appeared.</p><p><b>CONCLUSIONS</b>Postoperative adjuvant chemotherapy dose not significantly improve median survival among patients with completely resected stage IIIA-N2 NSCLC, but significantly improves the 1- and 2-year survival rate. It also dose not decrease the incidence of brain metastasis but puts off the time of brain metastasis.</p>

The diagnostic value of mediastinoscopy and its application in staging for lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the value of mediastinoscopy in diagnosing unknown mediastinal disease and staging of lung cancers.</p><p><b>METHODS</b>From October 2000 to August 2001, 41 patients were examined by cervical mediastinoscopy with or without anterior mediastinotomy for diagnostic and staging purposes. Of these 41 patients, 12 were for diagnosis of unknown mediastinal disease, 3 for diagnosis and staging of pulmonary nodule or mass clinically suspected to be malignancy and 26 for the staging of lung cancer.</p><p><b>RESULTS</b>Ten of 12 patients with unknown mediastinal disease were diagnosed pathologically as thymoma in 1, metastatic lesion from lung cancer in 1, metastatic thyroid carcinoma in 1, lymph node hyperplasia in 1, teratoma in 1, sarcoidosis in 1, inflammatory pseudotumor in 1 and tuberculosis in 3, giving a diagnostic rate of 83.3%. Of three patients with suspected malignancy, one was diagnosed as tuberculosis by cervical mediastinoscopy and the other two as lymphoma and pulmonary inflammatory pseudotumor by thoracoscopy and thoracotomy. The sensitivity and specificity of mediastinoscopy for the staging of mediastinal nodes in 26 lung cancers were 87.5% and 100%. Only one wound infection but no other major complication was found.</p><p><b>CONCLUSION</b>Mediastinoscopy is a safe procedure which can accurately provide information on diagnosis and staging.</p>

Surgical treatment for stage III N2 non-small cell lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the survival and prognostic factors of stage III N2 non-small cell lung cancer (NSCLC) after surgical treatment.</p><p><b>METHODS</b>266 patients with stage III N2 NSCLC underwent operation from 1982 to 1996, with the 5-year survival rate compared with those of stage N0 and N1 patients who received operation in the same period. Histological classification, number of positive nodes, location and extent of mediastinal lymph node involvement, T primary tumor status, complete or incomplete operation, the procedure of operation were univariately and multivariately analyzed to determine their impact on the 5-year survival.</p><p><b>RESULTS</b>The 5-year survival rate of patients with stage III N2 non-small lung cancer after surgical treatment was 17.3%, which was significant lower than those with N0 (51.4%) and N1 (30.4%). Four prognostic factors significantly influenced the outcome: number of positive nodes, location and extent of mediastinal lymph node involvement, T primary tumor status and complete resection of the tumor.</p><p><b>CONCLUSION</b>Patients with stage III N2 NSCLC are candidates for surgical treatment if they have evidence of limited mediastinal lymph node metastasis and prospects of complete resection.</p>

Prognostic factor analysis of pneumonectomy for non-small cell lung cancer / 中华外科杂志

<p><b>OBJECTIVES</b>To identify predictors of survival following pneumonectomy for non-small cell lung cancer (NSCLC) and provide evidence for the revision of patient selection criteria.</p><p><b>METHODS</b>81 cases of pneumonectomy for NSCLC from January 1990 to May 1996 at our hospital were reviewed retrospectively. There were 65 men (80.2%) and 16 women (19.8%), with a mean age 53.4 +/- 9.4 years (range 20 - 68 years). Predominant histological types included squamous cell carcinoma (54.3%), adenocarcinoma (24.7%), and squamoadenocarcinoma (17.3%). After follow-up for more than 5 years, data were examined using the chi-square test, Kaplan-Meier method, and Cox-mantel test. The possible factors affecting survival were tested with univariate and multivariate analysis.</p><p><b>RESULTS</b>The 5-year survival of N(0), N(1) and N(2) disease of NSCLC following pneumonectomy was (20.8 +/- 9.9)%, (15.4 +/- 10.0)% and (4.0 +/- 2.8)%, respectively. There was no perioperative death. The operative complications morbidity was 22.2%. Factors adversely affecting survival with univariate analysis included age over 60 years for right pneumonectomy, cardiopulmonary complications, adenocarcinoma, peripheral location, tumor greatest dimension more than 10 cm, chest wall involvement and N(2) disease. Factors adversely affecting survival with multivariate analysis included cardiopulmonary complications, greatest tumor dimension more than 10 cm, chest wall involvement and N(2) disease.</p><p><b>CONCLUSIONS</b>Pneumonectomy provides survival benefit with a high operative complications morbidity. Old age (>/= 60 years) for right pneumonectomy, cardiopulmonary complications, adenocarcinoma, and N(2) disease may be negative prognostic factors of long-term survival. Patient selection should be based on cardiopulmonary evaluation and the stage of disease.</p>

Clinical analysis of 10 patients with pleural mesothelioma in surgical treatment / 中国癌症杂志

Purpose:To investigate the clinical features,diagnosis, surgical treament and prognosis of pleural mesothelioma. Methods:A retrospective study was conducted in a total of 10 cases of pleural mesothelioma hospitalized from January 1980 to June 2000. Results: None of the 10 patients had history of exposure to asbestos,and the clinical manifestation were chest pain and feeling of compression,cough,shortness of breath. Pleural thickening or nodules were found in radiography examaination with or without pleural effusion.Of 10 cases,4 cases were localized type and 6 cases were diffused type, 8 cases received surgery(5 cases received radical operation and 3 cases received palliative operation) Conclusions:Exposure to asbestos or not has no definite relations to pleural mesothelioma,cytology examination of pleural effusion is not very helpful in pathologic diagnosis due to low positive rate.CT scan and pleural needle biopsy are helpful preoperatively. Surgical operation is the optional treatment in localized type and the prognosis is good,but prognosis is poor in diffused type and multimodality therapy is emphasized.